Preliminary Engineering Report Form for Subdivision Plat Approval

Page 1
Water Quality Division Preliminary Engineering Report Form
for
Subdivision Plat Approval
I. Subdivision/Development Information
1. Name of development/subdivision: ______________________________
2. County: ______________________________
3. Legal Description: ___ /4, ___ /4, ___ /4, of Section ______, T- ___ - ___, R - ___ - ___, I. M. / C. M., ______________
County
4. Developer: ___________________________________________________
5. Developer’s address: ___________________________________________________
6. Developer’s phone number: ___________________________________________________
7. Water will be supplied by: ___________________________________________________
8. Sewage will be received, transported, and treated by: ___________________________________
9. Number of lots (service connections) proposed: ___________________________________________________
10. A location map of the proposed subdivision/development is included? Yes ( ); No ( ). A location map is required.
11. Highest elevation in the proposed subdivision: ___________________________________________________
12. The elevation of the nearest water storage tower: ___________________________________________________
13. Water pressure at the point of connection of the subdivision: ___________________________________________________
14. The proposed waterline system is designed to maintain a minimum pressure of 25 psi at all points under all conditions of flow:
Yes ( ) : No ( )
15. Hydraulic analysis based on flow demands of one gallon per service connection and pressure requirements is used to size all
water mains: Yes ( ); No ( ).
16. Hydraulic analysis is provided (hydraulic analysis is required for the review process): Yes ( ); No ( ).
17. A minimum waterline size of six (6) inches in residential areas is proposed: Yes ( ); No ( ).
18. The normal static pressure throughout the area to be served will range from _______ to _______ psi.
19. The normal dynamic pressure throughout the area to be served will range from _______ to _______ psi.
20. Hydrants are provided at each intersection and at intermediate points so spacing does not exceed 600 feet: Yes ( ); No ( ).
21. Hydrants, with 4 ½ inch pumper outlets are to be connected to mains smaller than 6 inches: Yes ( ); No ( ). If Yes, explain
______________________________________________________________________________________________________
22. Where waterlines and sewer lines intersect the minimum vertical separation (edge to edge) is ________ inches.
23. Proposed waterline extension involves surface water crossings: Yes ( ); No ( ).
24. Onsite inspection of the proposed waterline construction will be inspected by:
Engineering Firm: Yes ( ); No ( ),
Owner: Yes ( ); No ( ), or
Other (please specify): ___________________________________________________
25. The area of the proposed development: _________________. If area of development is 5 acres or more, has the
developer/builder obtained a DEQ Storm Water Construction Permit: Yes ( ); No ( ). Developers/builders are required to
obtain a DEQ Storm Water Construction Permit for a construction site that will disturb five (5) acres or more in accordance with
OPDES, 27A O.S. 2-6-201 et siq.
26. One hundred year flood elevation: ___________________________________________________
I certify that, to the best of my knowledge, all the information provided in this engineering report form is correct and no significant
information necessary for a proper evaluation of the project has been omitted:
Signature of Professional Engineer: _______________________________ Date: ___________
Name of Professional Engineer: _______________________________
State of Oklahoma Professional Engineer No: ______________________________
Phone No: _(____)_________________________
Page 2
II. Public Water Supply System
1. System Name: __________________________________
2. PWSID Number: ____________
3. Source of water supply: ___________________________________________
Surface __________ , Ground ________, or Purchase __________
Community _________ or Non-Community ___________
4. Population served by proposed platted subdivision: ________________________________
5. Number of service connections (subdivision): ____________________________
6. Estimated total daily water demand: _________________________________________
7. System pressure at point of connection: _________________________________________
I, ____________________, the Authorized Representative for the _________________________, certify that _________________
will supply water to the proposed subdivision. The water system is adequate to supply quantity and quality of water to the proposed
subdivision and maintain the minimum pressure requirements of 25 psi at all points in the distribution system at all times.
___________________________________________________________
Signature of Authorized Representative for the Water Supply System
III. Community/Public Sewage System
1. System Name: ______________________________________________________________
2. Facility ID Number: S-_______________
3. Population served by proposed platted subdivision: ____________________________
4. Number of service connections (subdivision): ____________________________
5. Total estimated daily sewage generated by the proposed subdivision: ____________________________
I, ____________________, the Authorized Representative for the _________________________, certify that _________________
will receive transport and treat the sewage generated by the proposed subdivision. The Sewage Treatment Facility is adequate to treat
the waste as required by the Oklahoma Department of Environmental Quality.
___________________________________________________________
Signature of Authorized Representative for the Sewage Treatment Facility
IV. Water Quality Division
Reviewed By: _______________________
Position: _________________________
Date Approved: ________________________
Signature: __________________________

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Page 1
Water Quality Division Preliminary Engineering Report Form
for
Subdivision Plat Approval
I. Subdivision/Development Information
1. Name of development/subdivision: ______________________________
2. County: ______________________________
3. Legal Description: ___ /4, ___ /4, ___ /4, of Section ______, T- ___ - ___, R - ___ - ___, I. M. / C. M., ______________
County
4. Developer: ___________________________________________________
5. Developer’s address: ___________________________________________________
6. Developer’s phone number: ___________________________________________________
7. Water will be supplied by: ___________________________________________________
8. Sewage will be received, transported, and treated by: ___________________________________
9. Number of lots (service connections) proposed: ___________________________________________________
10. A location map of the proposed subdivision/development is included? Yes ( ); No ( ). A location map is required.
11. Highest elevation in the proposed subdivision: ___________________________________________________
12. The elevation of the nearest water storage tower: ___________________________________________________
13. Water pressure at the point of connection of the subdivision: ___________________________________________________
14. The proposed waterline system is designed to maintain a minimum pressure of 25 psi at all points under all conditions of flow:
Yes ( ) : No ( )
15. Hydraulic analysis based on flow demands of one gallon per service connection and pressure requirements is used to size all
water mains: Yes ( ); No ( ).
16. Hydraulic analysis is provided (hydraulic analysis is required for the review process): Yes ( ); No ( ).
17. A minimum waterline size of six (6) inches in residential areas is proposed: Yes ( ); No ( ).
18. The normal static pressure throughout the area to be served will range from _______ to _______ psi.
19. The normal dynamic pressure throughout the area to be served will range from _______ to _______ psi.
20. Hydrants are provided at each intersection and at intermediate points so spacing does not exceed 600 feet: Yes ( ); No ( ).
21. Hydrants, with 4 ½ inch pumper outlets are to be connected to mains smaller than 6 inches: Yes ( ); No ( ). If Yes, explain
______________________________________________________________________________________________________
22. Where waterlines and sewer lines intersect the minimum vertical separation (edge to edge) is ________ inches.
23. Proposed waterline extension involves surface water crossings: Yes ( ); No ( ).
24. Onsite inspection of the proposed waterline construction will be inspected by:
Engineering Firm: Yes ( ); No ( ),
Owner: Yes ( ); No ( ), or
Other (please specify): ___________________________________________________
25. The area of the proposed development: _________________. If area of development is 5 acres or more, has the
developer/builder obtained a DEQ Storm Water Construction Permit: Yes ( ); No ( ). Developers/builders are required to
obtain a DEQ Storm Water Construction Permit for a construction site that will disturb five (5) acres or more in accordance with
OPDES, 27A O.S. 2-6-201 et siq.
26. One hundred year flood elevation: ___________________________________________________
I certify that, to the best of my knowledge, all the information provided in this engineering report form is correct and no significant
information necessary for a proper evaluation of the project has been omitted:
Signature of Professional Engineer: _______________________________ Date: ___________
Name of Professional Engineer: _______________________________
State of Oklahoma Professional Engineer No: ______________________________
Phone No: _(____)_________________________
Page 2
II. Public Water Supply System
1. System Name: __________________________________
2. PWSID Number: ____________
3. Source of water supply: ___________________________________________
Surface __________ , Ground ________, or Purchase __________
Community _________ or Non-Community ___________
4. Population served by proposed platted subdivision: ________________________________
5. Number of service connections (subdivision): ____________________________
6. Estimated total daily water demand: _________________________________________
7. System pressure at point of connection: _________________________________________
I, ____________________, the Authorized Representative for the _________________________, certify that _________________
will supply water to the proposed subdivision. The water system is adequate to supply quantity and quality of water to the proposed
subdivision and maintain the minimum pressure requirements of 25 psi at all points in the distribution system at all times.
___________________________________________________________
Signature of Authorized Representative for the Water Supply System
III. Community/Public Sewage System
1. System Name: ______________________________________________________________
2. Facility ID Number: S-_______________
3. Population served by proposed platted subdivision: ____________________________
4. Number of service connections (subdivision): ____________________________
5. Total estimated daily sewage generated by the proposed subdivision: ____________________________
I, ____________________, the Authorized Representative for the _________________________, certify that _________________
will receive transport and treat the sewage generated by the proposed subdivision. The Sewage Treatment Facility is adequate to treat
the waste as required by the Oklahoma Department of Environmental Quality.
___________________________________________________________
Signature of Authorized Representative for the Sewage Treatment Facility
IV. Water Quality Division
Reviewed By: _______________________
Position: _________________________
Date Approved: ________________________
Signature: __________________________